Systems of Care A Promising Solution for Children with Serious
Emotional Disturbances and Their Families
We've supported and funded Systems of Care in nearly 40 of the 58 counties in the State of California for three obvious, yet profound reasons: our children are getting better; the families are satisfied with the results, and it is cost effective when compared with the old way of doing business.
Senator Cathie Wright
California State Senate
The Village Project has clearly made a difference. This multi-agency collaborative effort is spearheaded by the Charleston/Dorchester Community Mental Health Center; mental health professionals are co-located with my human services staff.
We have seen a reduction in the number of children being placed in foster care, as well as better service coordination for the children and families we serve in our community.
Ralph J. Terry
Program Director
Charleston County Department of Social Services (South Carolina)
At any given time, approximately 1 in every 10 young people in the U.S. has a serious emotional disturbance. Sadly, two-thirds of these young people are not getting the help they need. In response to this need, the U.S. Congress established the Comprehensive Community Mental Health Services Program for Children and Their Families. This grant program supports the development of comprehensive, coordinated, community-based, and culturally competent systems of care for children and adolescents with serious emotional disturbances and their families.
The main goal of this program is to build innovative home and community systems of care for children with serious emotional disturbances and their families, and at the same time, generate new knowledge about the most effective ways to meet the needs of children with serious emotional disturbances and their families. All 31 grant sites supported by the program participate in a national evaluation that is shedding new light on service outcomes, cost, and program effectiveness.
Any governmental entity, which is defined as any State, political subdivision of a State, and any Indian tribe or tribal organization, is eligible to apply for a grant, as long as the entity can provide matching funds. The governmental entity or grant applicant must propose an interagency, multi-disciplinary team of organizations to operate a system of care and to serve as the location through which children and their families are provided access to integrated supports and services.
In a system of care, mental health, education, child welfare, juvenile justice, and other agencies work together to ensure that children with mental, emotional, and behavioral problems and their families have access to the services and supports they need to succeed. These services and supports may include diagnostic and evaluation services, outpatient treatment, emergency services (24 hours a day, 7 days a week), case management, intensive home-based services, day treatment, respite care, therapeutic foster care, and services that will help young people make the transition to adult systems of care.
A true system of care is about partnership—a partnership made up of service providers, families, teachers, and others who care for a child. Together, the team develops an individualized service plan that builds on the unique strengths of each child and each family. This customized plan is always implemented in a way that is consistent with the family’s culture and language.
Julio’s Story
My son, Julio, is 14 years old. He was in a State institution for 6 years, and we didn’t see him much. The system of care staff came to meet our family and helped us get ready before Julio came home. The case manager listened to us and asked us what we needed.
I wasn’t sure what to say when the case manager asked me about our family’s strengths—the beliefs and activities that are most important to us. After I thought about it, it occurred to me that church and sports have always been a big part of our family life. He told me that we would keep those things in mind as we worked together to develop a personal service plan for Julio. A few days later, he asked me if I approved of Julio receiving therapy for his defiant behavior. He also requested my approval to enroll Julio in a drug prevention support group and to provide Julio with a mentor. I really appreciated the fact that he respected my authority as a father and asked for my input.
Help with Julio means that my wife and I are able to focus on our own issues. We now go to marriage counseling and family therapy. The program even helped us find a Latino doctor who was able to connect with Julio and explain to him why he needed to take his medicine.
If this program had existed 6 years ago, Julio would never have had to go away. Today, we
have the support we need to help Julio.
Craig’s Story
My 11-year-old son, Craig, was suicidal. He set fires. He killed animals. He was a danger to himself and everyone around him. My other three sons and I were afraid of him, especially when he was on illicit drugs.
After becoming involved in a system of care, the case manager asked me what services my family needed. I told him I was most concerned about Craig’s suicidal thoughts, his violent behavior, and his drug use. The case manager provided Craig with an adolescent psychiatrist, who prescribed anti-depressants, managed his medication, and kept him talking so he didn’t get so depressed. The school counselor, who worked with him and his teachers, was also part of the team. The case manager also arranged for Craig to go to his anti-drug support group so I didn’t have to miss work.
The people in the system of care really showed that they care about us as a family. They lifted us up and brought us closer. Today, Craig is on the honor roll at school. All the help from the men and women in the system of care has really paid off.
Yolanda’s Story
I had a great job working for a major airline, but I had to give up my job. My 16-year-old daughter’s school principal was always calling me to pick up Yolanda because she was creating havoc in the classroom. She simply wasn’t able to concentrate, and her disruptive behavior was a major distraction for other students.
Then a friend told me about a program that could help us, so I called. I took Yolanda to the program for an assessment, and I discovered that many of Yolanda’s problems could be attributed to attention-deficit/hyperactivity disorder. Yolanda’s service coordinator and I worked together to decide what mental health and other services Yolanda needed. Today, the program provides transportation to make sure Yolanda gets to school. She has tutors and takes music lessons. The service coordinator even connected her with a youth group, and she’s made lots of friends.
Now that I have people supporting me and my daughter, the system of care is working with the county employment office to help me find a job. After all the system of care has done for me and my daughter, I believe that we are going to be okay.
Milestones in Children’s Mental Health
1969
The Joint Commission on the Mental Health of Children acknowledged that large numbers of children with serious emotional disturbances and others with disabilities do not receive appropriate care.
1975
The Project on the Classification of Exceptional Children recognized that services for children were severely fragmented. This recognition resulted in the Education for All Handicapped Children Act (P.L. 94-142), which required that children between ages 3 and 21 with serious emotional disturbances be provided a free and appropriate education and the mental health services that are needed to promote learning.
1978
The President’s Commission on Mental Health, Task Panel on Infants, Children, and Adolescents, found that adolescents were one of the nation’s most underserved groups and recommended that mental health services be equitable with general health services. It also called for respecting ethnic differences, involving parents in the treatment process, and increasing funding for residential and outpatient care.
1982
The Children’s Defense Fund published Unclaimed Children, authored by Jane Knitzer. The report documented the plight of children and adolescents with serious emotional disturbances who were "unclaimed" by the government and community agencies responsible for their care.
1984
The National Institute of Mental Health implemented a planning initiative called the Child and Adolescent Service System Program.
1988
The Robert Wood Johnson Foundation launched the Mental Health Services Program for Youth (MHSPY), a $20.4 million initiative in eight States designed to integrate service systems for children with serious mental, emotional, and behavioral disturbances.
1992
The Comprehensive Community Mental Health Services Program for Children and Their Families is created (P.L. 102-321), based on system of care principles. This new initiative is administratively placed in the Child, Adolescent and Family Branch, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
1998
FY 1998 funding for the Comprehensive Community Mental Health Services Program for Children and Their Families is $73 million, serving 31 grants in more than 50 communities within 20 States, Indian tribes, or tribal organizations. More than 25 new Family Support Network grants were awarded and the Native American "Circles of Care" grant program was initiated.
What Makes a System of Care Unique?
* Every child and family receives an individualized service plan tailored to their unique needs.
* A full array of services and supports is provided in the home community in which the child lives.
* No child or adolescent is ineligible to receive services based on the severity of his or her behavior or disability. Providers do "whatever it takes" to ensure children, youth, and families receive appropriate services and supports for as long as they are needed.
* Services are delivered in the least restrictive, most natural environment that is appropriate for the child’s needs.
* Family members of children and youth who need mental health services work together with service providers to develop, manage, deliver, and evaluate policies and programs.
* Child- and family-serving agencies establish formal linkages to ensure that the system of care is adequately coordinated and integrated.
* Case management services are provided to ensure that the full range of services are delivered and to help the child and family move through the system as their needs change.
* Early identification and intervention are essential to promoting positive outcomes.
* Adolescents are ensured a smooth transition to the adult service system as they reach maturity.
* The rights of the child and family are always protected.
All services are delivered in a way that is responsive to the family’s culture.
Wraparound Milwaukee provides the opportunity for children to stay in the community and to receive services in the community that are based on individual family needs – recognizing that all families are different.
The Honorable Thomas P. Donnegan
Circuit Court Judge
Milwaukee County (Wisconsin)
Comprehensive Community Mental Health Services for Children and Their
Families Program
Grant Communities
Resources on Systems of Care
Publications
Children’s Mental Health: Creating Systems of Care in a Changing Society. Edited by Beth A. Stroul, M.Ed. Baltimore, MD: Paul H. Brookes Publishing Company, 1996.
Cole, Robert F., Ph.D., Poe, Stephanie. Partnerships for Care: Interim Report of the Mental Health Services Program for Youth. Washington, DC: Washington Business Group on Health, 1993.
Family-Professional Relationships: Moving Forward Together. Alexandria, VA: National Peer Technical Assistance Network, Federation of Families for Children’s Mental Health, November 1997.
Farmer, Betsy, Ph.D. Selected Experiences & Findings on Managing Care from the Comprehensive Community Mental Health Services Program for Children and their Families Grantees. Washington, DC: National Resource Network for Child and Family Mental Health Services, March 1996.
Isaacs, Mareasa R., Ph.D. & Marva P. Benjamin, ACSW. Toward a Culturally Competent System of Care, Volume II: Programs Which Utilize Culturally Competent Principles. Washington, DC: Georgetown University Child Development Center, 1991.
McCormack, Mary, Ph.D. There is Good News About Systems of Care. Washington, DC: National Resource Network for Child and Family Mental Health Services, February 1997.
Mental Health, United States, 1996. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1996.
Osher, Trina W. Getting Me On Your Team: Building Partnerships with Families. Alexandria, VA: Federation of Families for Children’s Mental Health, 1994.
Schoenberg, Sherry, M.A. Making It Happen: A Guide to Program Development for Services to Children and Adolescents who are Experiencing a Severe Emotional Disturbance and their Families. Washington, DC: National Resource Network for Child and Family Mental Health Services, 1997.
Stroul, Beth A., M.Ed. & Robert M. Friedman, Ph.D. A System of Care for Children and Youth with Severe Emotional Disturbances. Washington, DC: Georgetown University Child Development Center, July 1986, revised edition, 1994.
Stroul, Beth A., M.Ed., Lourie, Ira S., Goldman, Sybil K., Katz-Leavy, Judith. Profiles of Local Systems of Care for Children and Adolescents with Severe Emotional Disturbances. Washington, DC: Georgetown University Child Development Center, July 1992.
Tannen, Naomi. Families at the Center of the Development of a System of Care. Washington, DC: Georgetown University Child Development Center, April 1996.
Organizations
Federation of Families for Children’s Mental Health
1021 Prince Street
Alexandria, VA 22314
703.684.7710
www.ffcmh.org
National Resource Network for Child and Family Mental Health Services
Washington Business Group on Health
777 North Capitol Street, N.E. Suite 800
Washington, DC 20002
202.408.9320
www.wbgh.com
National Technical Assistance Center for Children’s Mental Health
Georgetown University Child Development Center
3307 M Street, N.W., Suite 401
Washington, DC 20007-3935
202.687.8635
http://gucdc.georgetown.edu
Caring for Every Child’s Mental Health: Communities Together Public
Education Campaign
1019 19th Street, N.W., Suite 1200
Washington, DC 20036
202.331.4323
National Mental Health Association
2001 N. Beauregard Street - 12th Floor
Alexandria, VA 22311
703.684.7722
www.nmha.org
Center for Effective Collaboration and Practice
1000 Thomas Jefferson Street, N.W.
Washington, DC 20007
202.944.5300
http://cecp.air.org
National Evaluation of the Comprehensive Community
Mental Health Services Program
Macro International Inc.
3 Corporate Square, Suite 370
Atlanta, GA 30329
404.321.3211
www.macroint.com
National Indian Child Welfare Association
3611 Southwest Hood Street Suite 201
Portland, OR 97201
503.222.4044
www.nicwa.org
Research and Training Center for Children’s Mental Health
Florida Mental Health Institute
University of South Florida
13301 Bruce B. Downs Boulevard
Tampa, FL 33612-3899
813.974.4661
www.fmhi.usf.edu
Research and Training Center on Family Support and Children’s Mental Health
Regional Research Institute of Portland State University
P.O. Box 751
Portland, OR 97207-0741
503.725.4040
www.pdx.edu
SAMHSA's National Mental Health Information Center
P.O. Box 42557
Washington, DC 20015
mentalhealth.samhsa.gov/child
800.789.CMHS (2647)
CA-0030
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